6 Days Remaining of 2013 Legislature
UNDER THE ROTUNDA
The finish line of the 2013 legislative session is within reach, with only six days left. At this point, every minute is critical to move bills. For a bill to survive at this point, it must get through the Texas House by tomorrow. Wednesday is the last day for the House to consider local and consent Senate bills on second or third reading and all third readings of Senate bills on the House Supplemental Calendar. Wednesday is also the last day for the Senate to consider all bills on second or third reading. What does second reading and third reading mean? First reading is when the bill is introduced and referred to committee. If the bill is voted out and set on a House or Senate calendar, the caption of the bill is read, and then the full membership debates the bill, offers amendments, and votes on it — this process is considered the second reading. If the bill is approved on second reading, it’s then taken up again by the full membership (usually the following day) for third reading and final passage. The good news is that many bills critical to TMA’s legislative agenda are moving through the Texas House and Senate. Here’s the short list.
Bills Cutting Red Tape Making Great Progress: House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston) is on the Senate Local and Uncontested Calendar today, which likely ensures its passage. HB 1803 would start the renewal of the Department of Public Safety (DPS) Controlled Substances Registration with the online medical license renewal at the Texas Medical Board.
Senate Bill 644 by Senator Huffman and Rep. John Zerwas, MD (R-Simonton), was approved by the House today. It requires the Texas Department of Insurance (TDI) to appoint a stakeholder workgroup to design a standard prescription drug prior-authorization form applicable across all payers, including Medicaid and the Children’s Health Insurance Program (CHIP).
Senate Bill 1216 by Sen. Kevin Eltife (R-Tyler) and Rep. Sarah Davis (R-West University Place) is on the House General Calendar today. It requires TDI to appoint a stakeholder workgroup to design a standard request form for prior authorization of health care services applicable across all payers.
MORE ACTION IN THE HOUSE
The House has approved several bills on third reading that are important to medicine:
- Senate Bill 8 by Sen. Jane Nelson (R-Flower Mound) and Rep. Lois Kolkhorst (R-Brenham) was approved with 15 amendments. Now, Senator Nelson must concur with those amendments or request a conference committee before the bill can advance. SB 8 validates the authority of the inspector general to detect and investigate fraud at all levels of the state health and human services system. If a physician or provider is found guilty of fraud or is disqualified from operating in another state due to fraud, he or she would be barred from operating in Texas. The bill also would move ambulance services to Medicaid HMOs and would reduce the use of ambulances for nonemergency transport.
- Senate Bill 24 by Sen. Chuy Hinojosa (D-McAllen) and Rep. Rene Oliveira (D-Brownsville) received unanimous support by the House. It establishes a new university in South Texas, including a medical school, within The University of Texas System. Senator Hinojosa must now concur with the two amendments added to the bill or request a conference committee.
- Senate Bill 58 by Senator Nelson and Representative Zerwas integrates behavioral health services, including mental health and substance abuse services and physical health services, under the Medicaid managed care program as opposed to having behavioral health "carve outs.” Senator Nelson now must concur with the four amendments added to the bill or request a conference committee.
- Senate Bill 1221 by Sen. Ken Paxton (R-McKinney) and Rep. John Smithee (R-Amarillo) ensures physicians know when their discounted contract rates under Medicaid managed care or CHIP are applied to products other than Medicaid or CHIP. The bill ensures managed care plans cannot apply physicians’ existing agreed-to discounts for their Medicaid/CHIP business to new commercial products in the health insurance exchange without notification and consent.
- Senate Bill 978 by Sen. Deuell, MD (R-Greenville), and Representative Davis would allow the Texas Medical Board to adopt rules regulating the use of local anesthesia and peripheral nerve blocks in an outpatient setting in which only local anesthesia and peripheral nerve blocks are used. This would prevent inappropriate use of anesthesia for significant procedures done in an outpatient setting. The bill is now on its way to Gov. Rick Perry’s desk.
Other bills important to medicine that received preliminary approval on second reading by the House yesterday include these:
- Senate Bill 7 by Senator Nelson and Rep. Richard Raymond (D-Laredo) aims to save money in the Medicaid program by expanding Medicaid HMOs to people with intellectual and development disabilities and to nursing home residents. Twenty-four amendments were added to the bill, including one prohibiting Texas from expanding Medicaid to low-income adults without the approval of the legislature.
- Senate Bill 227 by Sen. Tommy Williams (R-The Woodlands) and Representative Zerwas would allow physicians to dispense aesthetic pharmaceuticals in excess of the patient’s immediate needs without a pharmacist license. Drugs include bimatoprost for growing eyelashes; hydroquinone, a skin whitener; retinoid for improving skin; and metronidazole to treat rosacea.
Workforce: One bill running against the clock on the House Calendar today is Senate Bill 143 by Senator Nelson. The bill is critical for improving Texas’ physician workforce and graduate medical education (GME) as it is the vehicle selected by the Senate Finance Committee for allocating the $11.5 million in the 2014-15 state budget for GME expansions. It would establish a new grant program at the Higher Education Coordinating Board to encourage the development of new GME positions and programs. The bill also offers GME planning grants to hospitals to help develop new hospital training partners for Texas’ medical schools that may be eligible to receive Medicare GME funding. It also establishes two primary care incentive programs for medical schools and expands the Physician Education Loan Repayment Program to allow participation by physicians who provide services to Medicaid and Women’s Health Program patients.
Controlled Substances: Senate Bill 1643 by Senator Williams and Rep. Carol Alvarado (D-Houston) is before the Texas House today. SB 1643 improves access to prescription information by physicians. It allows them to delegate information retrieval to a nurse and allows for connection to DPS through a health information exchange, as long as proper security measures are in place to protect against disclosure to unauthorized individuals. The bill also allows physicians to include that information in a patient’s medical records, but that information would be subject to any applicable state or federal confidentiality or privacy laws.
Patient Privacy: Two TMA bills aimed at improving the state’s new privacy law for physicians were sent to the House Local and Consent Calendar and will be set tomorrow for full House consideration. They are Senate Bill 1609 and Senate Bill 1610 by Sen. Charles Schwertner, MD (R-Georgetown), and Representative Kolkhorst. The bills modify the privacy bill of last session to ensure streamlined training of staff and to prevent physicians from having to meet multiple state privacy requirements.
Obesity Prevention: House Bill 217 by Representative Alvarado and Sen. Carlos Uresti (D-San Antonio) was on the Senate Intent Calendar today and was approved. HB 217 would ensure only nutritional food choices are available for students to buy on public school campuses. TMA and the Public Health Coalition successfully lobbied for additional funds in the state budget related to the implementation and data assessment of the Fitnessgram used in public schools to assess physical fitness.
Tobacco Taxes: House Bill 3556 by Rep. John Otto (R-Dayton) and Senator Hinojosa imposes a tax on all cigarettes and tobacco products not covered by the tobacco settlement agreements. The bill was passed by the Senate today. It will now return to the House so it can concur with Senate changes or request a conference committee. The Texas Public Health Coalition worked to have language removed that called for taxing these new tobacco products at a lower rate than current ones.
Advance Directives: Last night, the House did not take any amendments on SB 7 related to advance directives — a subject that has dominated a significant amount of time this session for TMA. Since no other vehicles appear to be available to advance this discussion, the existing patient safeguards under the Texas Advance Directive Act will continue as well as the legal safe harbor that recognizes the right of physicians to adhere to their moral conscience.
PHYSICIAN OF THE DAY
The physician of the day at the Capitol is Troy Fiesinger, MD, of Sugar Land. Dr. Fiesinger graduated from Baylor College of Medicine in 1996. He is a member of TMA and the Harris County Medical Society.
WHAT WE’RE READING